Comparing the Effectiveness of Mindfulness-Based Stress Reduction and Emotion-Focused Therapy on Mental Rumination in Cardiovascular Patients

Background &

Cardiovascular diseases are the most common cause of death in most countries of the world. Statistics show that one-third of heart attacks lead to death, and in the other two-thirds, people do not recover completely. This statistic exists more or less in Iran as well, and imposes significant costs on individuals, families, health care system and society every year (1). Coronary artery diseases are the most important cardiovascular disorder and a major health problem in developing and industrialized countries. This disease is a type of insufficiency in the coronary arteries of the heart, which ultimately leads to a decrease and disturbance in the blood flow of the myocardium of the heart, and the stoppage of the blood flow of the myocardium causes a disturbance in the action of the heart muscle (2). In addition to the fact that cardiovascular diseases are considered as one of the most severe physical diseases, these patients also have special conditions in terms of psychological and personality. The results of various researches indicate that in addition to the presence of some personality traits that have an impact on the development of heart diseases, a number of cognitive characteristics can also act as the underlying, perpetuating or aggravating factors of these diseases. In this context, research findings show that heart patients are different from healthy people in terms of some cognitive variables such as hostility, cognitive flexibility, experiential avoidance, self-efficacy and self-control. In addition, these findings indicate that cardiovascular patients suffer from relatively high depression, anxiety and worry, which in turn causes mental rumination among them (4). Experimental evidence shows that engaging in mental rumination can lead to increased anxiety and irrational beliefs about oneself (8, 9). Since the cardiovascular patient during his physical illness, his activities are limited and he cannot show his usual abilities, therefore he becomes psychologically vulnerable and suffers from stress, anxiety, anger, depression and mental crisis. to be On the other hand, because medical treatments alone cannot lead to complete recovery of cardiovascular diseases, therefore, trainings and interventions based on psychosocial care, empowering patients in their efforts for self-care and revealing psychological obstacles to achieve Favorable medical and psychosocial outcomes seem essential. For this reason, during the last two decades, the need to perform psychological interventions to deal with psychological problems caused by cardiovascular diseases has been more and more noticed (17). Since research findings indicate that cardiovascular patients have a weaker state in terms of mindfulness and emotion regulation than healthy people, so if the interventions used for these patients can be focused on such characteristics, the results will be much stronger. it has. For this reason, the purpose of the present study was to compare the effectiveness of the mindfulness based  stress reduction and emotion- focused therapy on the mental rumination of cardiovascular patients in Isfahan city.

The research was conducted using a semi-experimental method with a pre-test, post-test and follow-up design along with a control group. The statistical population included 380 cardiovascular patients admitted to Shahid Chamran Cardiovascular Hospital in Isfahan in the winter of 2023, and 45 of them were selected by purposive sampling and randomly assigned to 2 experimental groups and one control group.. Then the patients of the experimental group (1) received 8 90-minute sessions of mindfulness-based stress reduction program and the experimental group (2) received 8 90-minute sessions of emotion-focused therapy. The measuring tool of the research was the mental rumination questionnaire (Nolen-Hoeksma and Davies-Morrow, 1991) and a short clinical interview which was completed in three stages. Research data were analyzed using variance analysis with repeated measures on one factor (mixed design).

The results of the research showed that the average scores of mental rumination in the pre-test, post-test and follow-up times were significantly different from each other. So that it was found that the average scores of mental rumination in the post-test and follow-up stages were significantly reduced compared to the pre-test stage (P<0.01), but no significant difference was observed between the average scores of the post-test and follow-up stages (P<0.01). . In this way, it was found that the mean scores of mental rumination in the post-test and follow-up phase decreased compared to the pre-test phase and this decrease is stable. Also, the intergroup effects showed that there was a significant difference between the mean mental rumination scores of the experimental and control groups with each other (P<0.01) and the effect coefficient was 0.256, which shows that about 26% reduction in mental rumination scores was caused by Interventions have been provided. The pairwise comparison also showed that the mean scores of mental rumination of the experimental groups were significantly lower than the control; In addition, the average mental rumination scores of the two intervention methods did not show any significant difference, and the effectiveness of both methods on reducing the average mental rumination scores of the patients was the same.

The results of the research showed that both methods of stress reduction based on mindfulness and emotion-focused therapy have the necessary capacity and ability and were able to affect the reduction of mental rumination in cardiovascular patients. Mindfulness was able to provide the conditions for change through the modification of cognition-emotion-behavior cycles. Since mental rumination is a cognitive variable and is directly related to the way a person perceives the condition of his illness and his life, therefore, mindfulness interventions provided the conditions to adjust and reduce it by creating positive marketization. On the other hand, because the main function of emotion-focused therapy is on the topic of emotion and it considers emotion as the basis of adaptation, therefore it helped patients to process complex situational information permanently and continuously and automatically in the direction of activities according to their needs. Take your own important steps. It seems that these two methods of intervention eventually led to improvement in emotional regulation and improvement in cognitive processes with two different effect mechanisms, which in turn resulted in a reduction in mental rumination in cardiovascular patients. In other words, because both methods of mindfulness based reduction stress and emotion-focused therapy are considered as bottom-up treatments, during which, by focusing directly on primary emotions, they make it possible to absorb negative thoughts and reduce the number of negative cycles, and therefore They cause a decrease in emotional and behavioral reactivity, therefore, the conditions for improving the patients' mental rumination were obtained. Finally, it was concluded that the stress reduction program based on mindfulness and emotion-oriented therapy can be used as a complementary treatment for cardiovascular patients.